Cholesterol-Lowering Supplements – Which One Should You Choose?

High cholesterol is becoming more and more common, due to higher rates of both screening and obesity, a major driver for developing the condition. As mentioned in a previous post, one of the best and safest ways to lower cholesterol is by following the TLC (or Therapeutic Lifestyle Changes) Diet, developed by the National Institutes of Health to help Americans lower their cholesterol levels by eating a heart-healthy diet and exercising regularly.

For some people, diet and exercise alone are not enough to get their cholesterol levels to where they need to be. These people are usually prescribed cholesterol-lowering medications, like statin drugs, which they often need to take for the rest of their lives. If the prospect of taking a prescription medication for the next 40 or 50 years seems daunting, there is what I consider to be an “in-between” option for when diet and exercise don’t work and taking a prescription drug isn’t the first choice on your list: over-the-counter supplements.

Supplements can be seen as a more “natural” way to lower cholesterol, since their active ingredients are naturally-occurring, rather than man-made. A “dietary supplement,” as defined by the Dietary Supplement Health and Education Act (DSHEA) of 1994, is a product “taken by mouth that contains a ‘dietary ingredient’ intended to supplement the diet.” These dietary ingredients include vitamins, minerals, herbs, and enzymes. While cholesterol-lowering medications, particularly statins, are some of the drugs most commonly-prescribed by doctors, cholesterol-lowering supplements are just as popular among consumers.

Perhaps the most well-known (and well-studied) cholesterol-lowering supplement is fish oil. Fish oil supplements contain the omega-3 fatty acids that are naturally found in oily fish like salmon, tuna, and sardines. These concentrated sources of heart-healthy omega-3s are commonly sold in capsule form and have few side effects, the most common being belching and a fishy aftertaste (although “belch-free” formulations are becoming more and more prevalent). Fish oil is generally safe to consume, although adverse effects such as an increased risk of stroke have been reported in people who consume greater than 3,000 mg, or 3 g, of fish oil a day. However, fish oil taken in lower amounts has been shown to be effective in lowering total cholesterol and triglyceride levels, reducing inflammation, and preventing heart disease and heart attacks.

Two other cholesterol-lowering supplements that have been in the news lately are krill oil and flaxseed oil. Krill oil is an up-and-coming “designer” alternative to fish oil. While krill oil may seem trendy, it also comes with a much higher price tag than fish oil, and its safety and effectiveness haven’t been adequately studied. What studies have shown, however, is that krill oil comes with a higher risk of side effects than fish oil, so it might not be a worthwhile investment, since it may not be safe and it hasn’t yet been proved to be effective. Flaxseed oil, a vegetarian source of omega-3 fatty acids, is generally thought to be safe to use, but it isn’t as effective as fish oil. Our bodies don’t absorb plant-based omega-3 fats as well as those that come from animal sources, so flaxseed oil doesn’t offer as much “bang for the buck” as fish oil does, since its cholesterol-lowering effects aren’t as potent. It remains, however, a good alternative for vegetarians or those concerned about the mercury content of fish oil supplements.

Before starting any supplementation regimen, talk with your doctor, as certain supplements can interact with medications or other supplements you may be taking. Also be aware that supplements are not regulated by the FDA, so you can’t be 100% sure if the supplements you purchase are going to be as safe and effective as their labels tout them to be. But if you must choose a supplement to lower your cholesterol levels, go with fish oil, as there is the most evidence out there on its safety and effectiveness.

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